New GOP healthcare proposal would allow waiver for essential health benefits, community rating: 6 things to know

In an effort to revive the ACA replacement bill, Republican leaders proposed a new plan Monday night that would allow states to waive two major ACA regulations conservatives say are driving up premiums.

Here are six things to know about the proposal.

1. Republican leaders met with lawmakers Monday to propose adding state waivers to the ACA replacement bill, which would allow states to repeal the essential health benefits requirement and the ACA's community rating, according to The Hill. The essential health benefits provision under the ACA requires payers to include 10 services on plans, including prescription drug coverage, childbirth and mental health services. The community rating rule prohibits payers from charging higher premiums based on pre-existing conditions or gender.  

2. The proposal was meant to sway conservative Republicans in the Freedom Caucus, according to The Hill. Vice President Mike Pence, Chief of Staff Reince Priebus and Budget Director Mick Mulvaney presented the proposal, according to The Washington Post. Caucus members said they were open to the idea, but want to see the legislative text first, according to The Hill.

3. The proposal does not repeal the ACA provision prohibiting payers from denying coverage to those with pre-existing conditions, as Rep. Mark Meadows, R-N.C., chairman of the Freedom Caucus, stressed, according to The Hill. However, if states eliminate the community rating, it could have a similar effect by pricing sick people out of the market.

4. Republicans say the $115 billion "stability fund" would protect people with pre-existing conditions from being priced out of the market, according to The Hill. The American Health Care Act's Patient and State Stability Fund would provide states funding to help develop high-risk pools.

5. Republican moderates could be convinced. Mr. Pence, Mr. Priebus and Mr. Mulvaney also met with the moderate Republican Tuesday Group on Monday evening. Attendees of this meeting told The Washington Post they felt it was possible they could come to an agreement.

6. An official legislative text is expected Tuesday. Republicans are saying a vote could happen as soon as this week, but that would mean lawmakers would have to vote without an analysis from the Congressional Budget Office, according to The Hill.


More articles on leadership and management:

Word from the C-suite: In a potential M&A deal, 'culture trumps all'
Express Scripts to cut 220 jobs
Hackensack Meridian Health co-CEO Robert Garrett: Hospitals should 'take the lead' on healthcare reform

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars